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Hematologic Malignancies • Radiation Oncology • Lymphoma • NCI-CCC Tumor Board Question • Internal Medicine • Hematology • T-Cell Lymphoma • UC Irvine • NCI-CCC Lymphoma Tumor Board Question
For a patient with ENKTL nasal type (nose/sinus involvement) who has hepatic toxicity with pegasparaginase but a CR after 2 cycles of chemotherapy with a plan for "sandwich" radiotherapy - what, if any, chemotherapy would you resume after completion of radiation?
I am not sure there is much efficacy for a regimen that does not include asparaginase. The patient received 2 cycles of P-GemOx, then was admitted for elevated bilirubin and transaminases with no other clear etiology.
Answer from: Medical Oncologist at Academic Institution
This is an interesting situation as there is not much data. The cure rate is high for early-stage disease after chemoradiation, even with VIPD and no asparaginase regimens (see de Pádua Covas Lage et al., PMID 36446856). Nature reviews which show in Table 2 survival curves similar for asparag...
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Answer from: Medical Oncologist at Community Practice
ENKTCL are often intrinsically resistant to anthracycline-based therapies due to high level expression of the multidrug resistant P-glycoprotein resulting in efflux of certain drugs from cancer cells, which underpins the importance of asparaginase in the management of this disease.However, there is ...